pure voice

Here's a terrific article written by a 10 year old boy who has type 1 diabetes. What I love most is that it demonstrates so clearly the work it takes to do diabetes well. I am so grateful for all the amazing knowledge and technology that we are armed with to live our lives well with diabetes. But it is not a cure and this article highlights that so eloquently through the voice of a wise and courageous child. His straightforward account of what he lives with every day helps shed a clearer light on what every diabetic lives with every day. And bringing more light to this often misunderstood disease is no small accomplishment! Even as I read it, having done what he does every day for so long, I'm still moved by what it takes to do this disease well. This boy's account helps me to see again, the reality of the experience of life with diabetes as I see his. And it also makes me very sad that he has to go through this at all.

Day in the life of a diabetic is lived strictly by numbers
Health - Ten-year-old Calvin Kocher has to do a lot of work keeping up with his dietary needs, but it doesn't keep him from engaging in typical activities
Saturday, May 06, 2006

CALVIN KOCHER
Editor's note: Calvin Kocher, 10, is a fifth-grader at Cooper Mountain School in Beaverton. In 2003, when he was 7, Calvin was diagnosed with Type 1 diabetes. He is a Portland ambassador for America's Walk for Diabetes, which takes place today. Here, Calvin describes a day in the life of a diabetic.

Picture yourself like this: You're very thirsty, you're always hungry, you have blurry vision, have lost weight and suddenly have urination problems. You go to the hospital, and your doctor says you're diagnosed with diabetes. Then you go to sticking yourself with a 1/4-inch-long needle 50 times a week.

That's what happened to me and more than 20 million people all over the United States of America. Are you scared now? Wait until you see our average days!

My day starts at 2 o'clock in the morning, even though I'm not awake. My dad comes in and tests the amount of sugar I have in my blood. Oops: I'm high. See, the normal range is 80 to 180. I'm 274. I have a portable IV that I carry in my pocket called a computerized insulin pump. It gives me insulin -- a hormone I need to stay alive -- constantly throughout the whole day. It's connected by an infusion set.

To give an example, insulin is like a drawbridge that connects the red blood cells to sugar wanting to get in. The insulin "drawbridge" lets the sugar in, which is then converted into energy. However, when you have diabetes, you don't produce insulin, so the sugar can't get in over the drawbridge. When your drawbridge is up, the cells are literally starving all the time because they are in need of glucose, even though your blood is thick with it. The body wants to wash out the extra sugar, and so you need to drink and go to the bathroom a lot. A lot can go wrong when that drawbridge isn't working properly, so my pump puts in insulin regularly via my infusion set. This constant input of insulin is called a basal rate.

So, back to our 2 a.m. blood check. Since my blood glucose is high, my dad gives me enough insulin to get it in range. You figure out how much insulin to inject by subtracting your goal from the high blood sugar and dividing by the patient's correction rate. My goal is 135 and my correction rate is 50. So 274 (my reading) minus 135 (my goal) equals 139 (the amount I need to come down). Then he takes the 139 and divides it by 50, which equals 2.78 units of insulin. So, he programs my insulin pump to inject that much insulin into me via my set. This extra boost of insulin is called a bolus. Everything is normal and peaceful -- until morning comes.

Today is a Saturday, which means it's a soccer game day. The game is at 11 o'clock. I wake up at about 9:30, get my contact lenses in and head downstairs for breakfast. I read the paper as I test. Oh, look, Phoenix won!

Beep-beep-beep! That's my meter. I'm 146. Perfect! I'm having two waffles (30 carbs), honey (15 carbs), butter and milk (15 carbs). So, 30+15+15 = 60 grams. My breakfast ratio is 1 unit of insulin to 10 carbs, so I bolus 5.75 units, because I'm going to be burning a lot of carbs with all the exercise at the soccer game. Then I eat, bolus and we head off to the soccer game.

As we get there, I take off my sweat suit and head off to warm up. Then, just before we take the field, I test. I'm 131. Normally, this would be perfect, but since I'm going to be exercising, I drink some Gatorade and jog onto the field.

At halftime, I test again: 187. Good! I don't do anything. But later in the half, I feel low. You know what it feels like to be low? It's like running a marathon with only water to quench your thirst. You'd feel woozy, ready to drop and ravenous, right? That's what it feels like to be low. So, my dad calls me off the field. Yikes! I'm 39! I quickly slurp my whole Gatorade, and 10 minutes later, after testing to affirm that I'm at a good level again (107), I go back on the field to savor the last five minutes of a 6-2 win.

At the end of the game, I test again. Oh, good! I'm 156, so I can eat the after-game snacks: fruit punch and a bag of chips. I will need to bolus for them. So, 30 carbs for the juice and 15 carbs for the chips is 45 carbs; on a 1:15 midday ratio, that's three units. I bolus, and then, because I was exercising, I activate a setting on my pump that, for a short time, lets me reduce the basal rate of insulin my pump puts in. This is called temporary basal rate. The basal insulin is the amount of insulin that my pump puts into my body continuously. My normal basal rate is about .8 units per hour.

In good spirits, we go to Outback Steakhouse for lunch. I order a steak, a baked potato, diet Dr Pepper and a sundae. Then, after we order, I test: 126. When the food arrives, I bolus: 60 for the potato and toppings, zero for the steak and the soda (they are carb-free) and 60 for the sundae. On a 1:18 ratio, that's 6.67 units. So I bolus, and we dig in to our food like stray dogs at a deli.

At 3 o'clock, I go outside to eat a Popsicle and grab a bag of pretzel/cheese sandwiches and relax in the hammock. This is a snack I don't have to bolus for. I look forward to it every day. Eating without testing and bolusing: It seems so normal for everyone else, but for me it's a luxury.

At dinner outside, we're having creamed corn, my mom's really good deep-fried potato slices and steak. I rack it all up. My number's a bit high -- 324 -- so maybe I shouldn't have had the Popsicle. Anyway, 324 minus 135 equals 189, and 189 divided by 45 equals 4.2 units, plus the meal. Milk's 10 carbs, potatoes are 50, creamed corn is 30, steak is zero and a Fudgesicle is 15; that makes 105, divided by my dinner ratio, 1:20, is 5.25 units plus the 4.2 units from earlier, which makes 9.45 units. It's a lot of insulin, but that's what I need. I bolus, and we eat.

Later, right before I go to bed, I test. Terrific! I'm 110, so I eat a half a banana (15 carbs) so I won't go low overnight. Then I go to bed, waiting for yet another eventful d

I want to let you know that Calvin’s episode on "Cooking Up A Story" is now on Google video, and can be viewed directly from this link: http://video.google.com/videoplay?docid=-6009218695086084963&hl=en

Thank you for letting me know about Calvin's episode on Cooking up a Story. It was wonderful. Calvin is a remarkable boy and you and your family are such a great support to him. I think his clear and straightforward voice could change the world!

I must thank you for the efforts you have put in penning this blog. I'm hoping to check out the same high-grade content by you in the future as well. In fact, your creative writing abilities has inspired me to get my own site now ;)